Authors: Thomas Bannister, Rena Fletcher, Sivanthi Sivanadarajah / Editor: Charlotte Davies, Liz Herrieven / Codes: CC15, CC7, CC8, SLO11, SLO12, SLO7 / Published: 22/03/2022
In May 2021, as we emerged from the second wave of Covid in the UK, we felt the time was right to make a change. Covid had highlighted significant racial health inequalities. A year earlier, the murder of George Floyd had put racism at the top of the global agenda, and it had largely stayed there thanks to the Black Lives Matter movement. It seemed that the moment was ripe to tackle racism. There was interest, and energy to make a change. So we launched EmbRACE.
EmbRACE is a grassroots anti-racism campaign. We’re based in an Emergency Department in the North West of England. We try to make continuous felt improvements in the lived experience of People of Colour in the healthcare system. We do what we can, where we are, in the present moment.
EmbRACE is: about race, for racial equity, by everyone. Here and now.
Discrimination is deeply ingrained in our society, and in ourselves. Each of us carries racist, sexist, homophobic, transphobic, ableist, and ageist views. They are reinforced in our media, work places, and families. We have grown up socialised into these discriminatory ideas because we have grown up in an inequitable global society. They are the lenses through which we look at the world, and most of the time we don’t even notice that they distort the picture. Discrimination is not an abnormality where good people sometimes do bad things; it is inherent in the very structure of our society. Discrimination is ‘normal’.
If you’re interested in addressing issues of social justice in your Emergency Department, then this blog is an offering to you. It’s a distillation of what we have learnt from setting up and running an anti-racism campaign. We hope it will serve you as you pursue your own social justice cause.
If you don’t think your Emergency Department needs a social justice campaign, then we invite you to consider the following:
- Nearly half of preventable emergency hospital admissions between 2001-2013 arose from social inequality
- In 2019/2020 there were more than twice as many Emergency Department attendances for the 10% of the population who live in the most deprived areas compared with the 10% who live in the least deprived areas
- Amongst your colleagues, more than 75% of doctors surveyed by the British Medical Association in 2021 had experienced racism at least once in the last two years, and almost 20% had left, or considered leaving, their job as a result of racism
- Read our blog on health inequalities for some more information and statistics.
Don’t wait for someone else to do it. Don’t wait for permission to do it. Don’t wait until you’ve learnt a bit more, or chosen a better name for your campaign. Discrimination persists because we put off addressing it. If you’re hesitating, be honest with yourself about why. Don’t allow yourself excuses. Inequity is a feature of our current society. Your Emergency Department is not exempt. You do not need more data to justify your campaign. Get out there and state your intention. “I want to work on addressing inequity related to race/gender/age/sexuality/ableism in our society, and in our Emergency Department.” At the beginning, it doesn’t need to be anything more than that.
Start with yourself
The only thing we can really control is ourselves. Our thoughts, feelings, and behaviours. How we show up in the world. If you want to change society, start with yourself. After all, society is just a lot of individual “selves”. You don’t need to achieve an enlightened state before you can encourage other people to examine their own biases, but commit, above all else, to doing your own self work.
Our current reality is inequitable. However, it is familiar and we are invested in it, even though it doesn’t serve us. Change can be uncomfortable and confronting. Expect resistance to the changes you are trying to make. Not only resistance from other people, but resistance from within yourself as well. Change happens outside our comfort zone. In the liminal space, between who we were and who we are becoming, we often experience significant discomfort. Hold on, persevere, lean in. And remember what this feels like, so you can empathise with others who are also experiencing the discomfort of their own transformation.
Speak your truth
Research papers, articles, and surveys can, and will, be challenged. Their conclusions will be resisted, and their methodologies will be picked apart. The only incontestable truth is your own perspective and experience. Share it. With humility, tell people about what your own journey towards social justice looks and feels like. With curiosity, invite them to share their own perspective and experiences. Beware of ‘gaslighting’, a form of manipulation, where people will tell you that you don’t really feel the way you think you do. Call out gaslighting, and hold onto your truth.
You don’t need an invitation
An inequitable society harms all of us. It tramples on values, such as fairness, that most of us hold dear. The work of addressing oppression should not fall to the oppressed. Being subjected to discrimination offers a unique perspective into how oppression works, but it does not necessarily equip someone to oppose it. In fact, those who are subject to oppression are often the least well resourced to address it. Due to a lifetime of discrimination, they may have less time, money, education, or hierarchical power than you. If you occupy a position of privilege, such as being a straight, White, man, you may be very well resourced to do the work, as long as you approach it with humility. You don’t need an invitation to get involved.
Talking about it doesn’t make it worse
Silence perpetuates discrimination. Talking about the inequity that already exists in society doesn’t make it worse. On the contrary, it acknowledges and validates the lived experiences of people who are discriminated against. It surfaces the issues, breaks down taboos, and encourages us to critically examine injustice.
Ask for support not permission
Addressing issues of social justice is a moral imperative. You do not require permission to do this work. Don’t bring your employer into disrepute, but don’t wait for approval or endorsement to get going. Consider asking your organisation to support your social justice work in concrete ways. For example: paid time to dedicate to your campaign, funding for your activities, funding for relevant training, access to coaching and mentoring, access to data that helps you better understand the issue you’re focussed on and the community you’re working with, access to official communication channels, and introductions to contacts in the wider network.
Inclusion is about everyone
Culture is the accumulation of people’s attitudes and values, expressed in their behaviours. Culture emerges from the group, from society. We can only change culture together. Social justice is fundamentally about inclusion. We can’t advance inclusion by excluding people. A campaign that alienates or vilifies people creates new forms of division and oppression. Ultimately, we’re all in it together.
Meet people where they are
Within the community there will be different levels of knowledge about issues of social justice. Everyone you encounter will be starting from a different point. To include them in the journey, we need to go and meet them where they are, rather than shouting for them to get over here. So reach out with compassion and curiosity, not judgement and condemnation.
Simple and positive, with a call to action
Inequity, discrimination, and oppression are complex issues, and our understanding of them continues to evolve. However, your community might not have the time, interest, or energy to really get deep into these issues. Can you encourage them to explore and reflect, whilst also offering them simple, positive steps that they can take which will help to advance social justice? Try to identify the next thing that will make a difference to your cause and invite people to do it. Simple, positive, action oriented.
The work of social justice is emotionally demanding. You can’t give from an empty cup. Set boundaries that allow you the time to replenish yourself with nourishing activities. Be kind to yourself, prioritise self-care. Be kind to the people that join you, ensure they can access the support they might need. Be kind to your community, because ultimately we’re all in it together.
The journey is the destination
Society will always be a work in progress. Our social reality is something we co-create with every interaction. Every word, smile, or gesture nudges our culture this way or that. Culture shapes us, and we shape it. Embody social justice in every aspect of the way you live. Become a beacon that draws society towards a more equitable way of being. But understand that we are constantly building the world we live in. So whilst we may achieve a more equitable equilibrium, we will never reach a fixed, utopian end state. There is no final destination. The journey is the destination.
‘How’ and ‘Why’ are essential, ‘What’ will emerge
For your social movement to grow, people must take up the mantle and express their support in their own ways. This can only happen coherently if everyone is clear about the goal (‘Why’), and the approach you are taking to achieve it (‘How’). If you get your strategy right then the group can self-organise and start new initiatives (‘What’) that still align to your goals and conform to your approach. For example: EmbRACE’s goal is to “achieve continuous felt improvements in the lived experience of People of Colour, in pursuit of racial equity”; that’s ‘Why’ we do what we do. Our strategy is to “Learn Independently”, “Share and Transform Together”, to “Change and Challenge Behaviour”, and to “Care for Ourselves and Support Each Other”; that’s ‘How’ we do it. We also have a document that sets out our approach in more detail, for instance, we “focus on identifying, sharing, and practising positive steps towards active anti-racism”. So, any member of EmbRACE can start a new initiative as long as it aligns to our goal, reflects our strategy, and conforms to our approach.
Say no strategically
Strategy is about choice. Choose what your campaign will focus on. But more importantly, choose what you’re not going to do. Saying no is hard, but effective and sustainable campaigns retain their focus. Do one thing well. Ruthless clarity will keep you on track. How does what you’re doing right now advance the cause you’re working on?
Watch out for ‘whataboutism’
If you’re running an anti-racism campaign, you might be asked, for instance, “what about sexism?” Well, what about it? Yes, it’s a serious issue that needs to be addressed. Please feel free to go ahead and do some work on it. But our work at EmbRACE is on racism. That doesn’t stop work from being done on sexism, or any other form of discrimination. In fact, our work will touch on all forms of discrimination (see next point), but it unapologetically focuses on one of them.
To focus on one, is to work on all
Different forms of discrimination interlock and reinforce each other. Author and activist Audre Lorde was a homosexual, Black, woman. She faced discrimination in relation to each of these facets of her identity. This is an example of intersectionality, a term coined by Professor Kimberlé Crenshaw. Whichever aspect of identity we focus our social justice work on, we naturally include all others. So, if you run an anti-racism campaign with an inclusive approach, you’re also working to improve the lives of, for instance, queer, diversely-abled, women, because people affected by racism includes the whole cross-section of society. So keep your focus, and don’t despair. Your work touches on the lives of everyone facing oppression.
Consider what you centre
It is normative in the UK to ‘centre’ the heterosexual, White, male experience. Notice that I have already done so in this blog. The straight, White, male experience is usually the reference point to which others are relative. What we centre, and how we centre it, speaks to where our attention is and where we direct our resources. An anti-racism campaign could centre White people. It could acknowledge that hierarchical power largely rests with White people, and that changes in White attitudes and behaviours could dramatically advance the cause of anti-racism. But do White people really need more attention and investment in a racial inequitable world? On the flip side, diversity and inclusion initiatives often centre People of Colour, but carry an implication that People of Colour need to develop resilience in order to advance within their organisations. Both of these approaches arise from the same underlying simplistic narrative: ‘racism wouldn’t be a problem if White people were nicer to People of Colour, or if People of Colour learnt to stand up for themselves and meet White standards’. With the narrative exposed, we can see how it supports the existing inequitable social structure. We can examine the narrative and discard it. We need a new paradigm; racism is a complex structural issue, it is a normal feature of our society and institutions. So, take note of what your campaign centres, how it frames it, and what that says about your view of the world. To understand this further, read more about reformist reforms, which entrench the current paradigm, and non-reformist reforms, such as “defund the police”, which envisage a new reality.
In November 2021 we were invited to present our work at the RCEM Showcase of Good Practice. The video we presented can be found here.
- The University of York. Health Inequalities and the A&E Crisis. Centre for Health Economics (CHE).
- The Royal College of Emergency Medicine. Health inequalities: what can we do in Emergency Medicine? RCEM President. May 2021.
- Doctors consider high levels of racism in the NHS to be a ‘debilitating’ problem, finds largest survey of racism in medicine. BMA media team, press release. February, 2022.